'You have to have an assessment!'

HONG KONG—I am easily irritated by what I take to be stupid comments or questions, especially ones that convey a bureaucracy with which I don’t agree.

“You have to have an assessment” was the response in Hong Kong when I tried to use an indoor climbing wall.

“But I’ve been climbing for nearly 30 years,” I replied.

“You have to have an assessment!” was the firm response with that “the-issue-is-now-closed” look that the charming but invariably inflexible person behind a desk in Hong Kong conveys so well.

“Can I have an assessment?” I asked, conceding that safety is an important issue and that they had no proof I could climb safely.

“You have to make an appointment” was the reply, at which point I turned and walked out, deciding that my training regime would have to be suspended during this trip to the Far East.

The incident reminded me of a friend who graduated as a nurse in the United Kingdom and, after moving to Hong Kong, was required to pass a local exam prior to practicing. As she had graduated from my own alma mater (Edinburgh) and from the school where I first taught, this offended me ... until!

We do exactly the same in the United Kingdom to all incoming nurses; we even ask native English-speaking nurses (North Americans and Australians) to take an English language test (IELTS or TOEFL) to quite a high standard before they can register. They also have to have a period of induction prior to practice. The Australians have reciprocated by insisting that incoming nurses also take an English test, including native UK nurses.

I have mixed feelings about the need for all this assessment and for the resulting assessment industry that has grown up around it (a view I won’t be expounding on too much at the reception I’ve been invited to attend by the Commission on Graduates of Foreign Nursing Schools during the upcoming meeting and annual conference of the American Academy of Nursing in Washington, D.C.). I can see that safety is paramount, and guaranteeing the competence and educational level of everyone arriving from a foreign country with a nursing registration is crucial and, probably, impossible without a formal approach. However, when I arrive in Washington, DC, as I could do here in Hong Kong, I can produce my driving licence and hire a car with the likelihood of killing a great many more people than if I turned up to work as nurse. This is only an analogy. Nursing is infinitely more complex than driving, but the principle applies, and I see no efforts in any country to streamline and accelerate the processes.

I have no solution to the problems encountered by nurses who wish to migrate or just gain experience outside their own country. In fact, I can acknowledge that there is a need for some “barriers” to free movement of registered nurses. I know very well how a rash of scandals involving non-native nurses in the United Kingdom leads to calls for tighter regulations. In addition to protecting patients, these regulations protect the nurses from beyond our borders who are practicing safely and making a major contribution to our National Health Service. All this is notwithstanding the fact that registered nurses from anywhere within the European Community can work in the United Kingdom without let or hindrance, including an English language test.

So, I did not manage to do any climbing in Hong Kong. But if you have read this entry to my blog, I hope you will think I have made reasonably good use of the time that was freed up.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.